Clinical Audit Pharmacist, Specialist - On-site - Full-time (Montgomery, Alabama)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Clinical Audit Pharmacist, Specialist to join our growing team.

Job Summary:

The Audit Pharmacist, Specialist plays a crucial role in evaluating claims, policies, and providing recommendations to the Pharmacy and applicable Program staff. This position demands a combination of clinical expertise, proficiency in claims processing and policy, and adeptness in pharmacy operations.

***This is an on-site position based at the Alabama Department of Medicaid in Montgomery, Alabama. The candidate must hold an active license in the state of Alabama to be considered for the role.***

Job Responsibilities:

• Review pharmacy claims to verify they are paid appropriately in accordance with state and federal regulations.
• Thoroughly review and evaluate claims, policies, and procedures linked to Medicaid's Pharmacy and applicable Program.
• Provide actionable recommendations and strategic insights to improve the efficiency and compliance of pharmacy services within the Medicaid program.
• Monitor pharmacy claims for potential signs of fraud, waste, and/or abuse.
• Manage the Hemophilia Standard of Care (SOC) along with yearly audits and SOC provider agreements.
• Monitor Value Based Agreements for outcomes.
• Manage out-of-state pharmacy enrollment and conduct yearly audits to monitor compliance with state and federal regulations.
• Ensure 340b compliance.
• Provide provider education, when necessary, in regard to appropriate billing practices in accordance with state and federal regulations.
• Provide clinical and administrative assistance to staff.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications/Experience:

• Bachelor's degree in pharmacy.
• Must be a Licensed Pharmacist who holds an active and unrestrictive license in the State of Alabama.
• Minimum of 3+ years' experience in outpatient/community pharmacy within the last 5+ years.

Preferred Qualifications/Experience:

• Doctor of Pharmacy Degree.
• Demonstrate exceptional clinical competence and proficiency in pharmacy operations to facilitate rigorous auditing activities.
• Ability to work cooperatively with others; comprehension of the current standards of pharmacy practice; and understanding of the challenges of professional pharmacy practice.
• Ability to master computer/software applications necessary for completing job tasks as assigned.
• Ability to manage multiple employees and workloads at once and meet contractual deadlines.
• Excellent verbal and communication skills.
• Excellent research and writing skills.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.